Provider Demographics
NPI:1750522298
Name:SANTOS, VLADIMIR (MD)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 SW 23RD ST
Mailing Address - Street 2:201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1419
Mailing Address - Country:US
Mailing Address - Phone:786-953-8221
Mailing Address - Fax:
Practice Address - Street 1:7490 SW 23RD STREET
Practice Address - Street 2:201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3031
Practice Address - Country:US
Practice Address - Phone:786-953-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN2892084A0401X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001721300Medicaid
FLDE583XMedicare PIN